| Entity Name: | INTERCOMMUNITY CANCER CENTER - LADY LAKE CAMPUS, L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Co.
INTERCOMMUNITY CANCER CENTER - LADY LAKE CAMPUS, L.L.C. is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Inactive
The business entity is inactive. This status may signal operational issues or voluntary closure, raising concerns about the business's ability to repay loans and requiring careful risk assessment by lenders. |
| Date Filed: | 20 Aug 2001 (24 years ago) |
| Date of dissolution: | 26 Sep 2014 (11 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (11 years ago) |
| Document Number: | L01000013946 |
| FEI/EIN Number |
593738703
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 301 SOUTH LAKE STREET, LEESBURG, FL, 34748 |
| Mail Address: | 301 SOUTH LAKE STREET, LEESBURG, FL, 34748 |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1013903699 | 2005-09-20 | 2012-01-30 | PO BOX 863359, ORLANDO, FL, 328863359, US | 922 ROLLING ACRES RD, LADY LAKE, FL, 321595022, US | |||||||||||||||||||||||||||||
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| Phone | +1 352-326-2224 |
| Fax | 3523268335 |
| Phone | +1 352-753-6198 |
Authorized person
| Name | HAL M JACOBSON |
| Role | MEDICAL DIRECTOR |
| Phone | 3523262224 |
Taxonomy
| Taxonomy Code | 2085R0001X - Radiation Oncology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RR MEDICARE |
| Number | DE8303 |
| State | FL |
| Issuer | MEDICAID |
| Number | 273918600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SCOTT KENNETH | Agent | 1048 JULIETTE BLVD, MOUNT DORA, FL, 32757 |
| HAL MARTIN JACOBSON FAMILY TRUST | Manager | 301 SOUTH LAKE STREET, LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | - | - |
| CHANGE OF PRINCIPAL ADDRESS | 2012-03-28 | 301 SOUTH LAKE STREET, LEESBURG, FL 34748 | - |
| CHANGE OF MAILING ADDRESS | 2012-03-28 | 301 SOUTH LAKE STREET, LEESBURG, FL 34748 | - |
| REGISTERED AGENT NAME CHANGED | 2007-03-22 | SCOTT, KENNETH | - |
| REGISTERED AGENT ADDRESS CHANGED | 2007-03-22 | 1048 JULIETTE BLVD, MOUNT DORA, FL 32757 | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-03-06 |
| ANNUAL REPORT | 2012-03-28 |
| ANNUAL REPORT | 2011-04-14 |
| ANNUAL REPORT | 2010-03-24 |
| ANNUAL REPORT | 2009-03-16 |
| ANNUAL REPORT | 2008-03-31 |
| ANNUAL REPORT | 2007-03-22 |
| ANNUAL REPORT | 2006-05-31 |
| ANNUAL REPORT | 2005-05-04 |
| ANNUAL REPORT | 2004-03-25 |
Date of last update: 02 Apr 2025
Sources: Florida Department of State
